COC EXAM STUDY GUIDE WITH ALL CORRECT & 100%
VERIFIED ANSWERS (UPDATED TO PASS)
AMBULATORY PAYMENT CLASSIFICATION Correct answer-APC
CHARGE DESCRIPTION MASTER Correct answer-CDM
CENTERS FOR MEDICARE AND MEDICAID SERVICES Correct answer-CMS
OUTPATIENT PROSPECTIVE PAYMENT SYSTEM Correct answer-OPPS
OUTPATIENT CODE EDITOR Correct answer-OCE
AMERICAN COLLEGE OF SURGEONS Correct answer-ACS
AMBULATORY SURGICAL CENTER Correct answer-ASC
CRITICAL ACCESS HOSPITAL Correct answer-CAH
COMPREHENSIVE OUTPT REHAB FACILITY Correct answer-CORF
CURRENT PROCEDURAL TERMINOLOGY Correct answer-CPT
HEALTHCARE COMMON PROCEDURE CODING SYSTEM Correct answer-HCPCS
AMERICAN HOSPITAL ASSOCIATION Correct answer-AHA
MEDICARE SEVERITY DIAGNOSIS RELATED GROUP Correct answer-MS-DRG
physician must be immediately available; does not have to be in the room Correct answer-general
supervision
Service is under physician's control; provider must be directly available and on campus. Correct
answer-direct supervision
provider must be in the room during service Correct answer-personal supervision
*doctor and anesthesiologist fees
*durable medical equipment (DME)
*prosthetic devices
*ambulance services
*outside lab services
*certain drugs and biologicals Correct answer-Not included in APC reimbursement (may be billed
out separately from hospital): (6)
DURABLE MEDICAL EQUIPMENT Correct answer-DME
licensed physician, two - five years training Correct answer-Residents
physicians obtaining additional training Correct answer-Fellows
, coding within the charge master Correct answer-hard coding
OFFICE INSPECTOR GENERAL Correct answer-OIG
payment methodology where hospitals are reimbursed based on procedures performed in an outpt
or ambulatory facility. Correct answer-APC (ambulatory payment classification)
reimbursement method for inpatients Correct answer-MS-DRG (Medicare severity diagnosis
related group)
first year following graduation from med school; one year rotation Correct answer-Interns
STATUS INDICATOR Correct answer-SI
Medicare supplemental insurance plans; fill the gap between Medicare insurances Correct answer-
Medigap
Inpatient co-ins and deductibles Correct answer-Part A Medicare covers:
notice to a patient that a service may not be covered by Medicare, must be signed. Correct
answer-ABN (advanced beneficiary notice)
*Workers comp
*Auto accidents
*Employer group health plans
*1st month ESRD patients Correct answer-Medicare is secondary payer to: (4)
ADVANCED BENEIFICIARY NOTICE Correct answer-ABN
coding is done by personnel from other departments Correct answer-soft coding
condition code 20 and modifier GA Correct answer-If a patient refuses to sign or pay an ABN, but
still wants the service performed, what Condition Code and Modifier would be on the claim?
condition code 20 and modifier GZ Correct answer-If the patient demands the claim be sent to
Medicare, what condition code and modifier would be on the claim?
ABN not required, patient wants Medicare responce Correct answer-ABN condition code 20
Service is not covered, but denial from Medicare is needed for secondary insurance (all denied items
must be on a separate claim for Medicare) Correct answer-ABN condition code 21
ABN required for labs Correct answer-ABN condition code 32
True Correct answer-TRUE / FALSE
ABN's may not be used for bundled services
Used by MACs, identifies errors on claims, assigned APC number for services covered under OPPS.
Correct answer-OCE (outpt code editor)
created by OIG; compliance program guidelines for hospitals Correct answer-Federal Register
VERIFIED ANSWERS (UPDATED TO PASS)
AMBULATORY PAYMENT CLASSIFICATION Correct answer-APC
CHARGE DESCRIPTION MASTER Correct answer-CDM
CENTERS FOR MEDICARE AND MEDICAID SERVICES Correct answer-CMS
OUTPATIENT PROSPECTIVE PAYMENT SYSTEM Correct answer-OPPS
OUTPATIENT CODE EDITOR Correct answer-OCE
AMERICAN COLLEGE OF SURGEONS Correct answer-ACS
AMBULATORY SURGICAL CENTER Correct answer-ASC
CRITICAL ACCESS HOSPITAL Correct answer-CAH
COMPREHENSIVE OUTPT REHAB FACILITY Correct answer-CORF
CURRENT PROCEDURAL TERMINOLOGY Correct answer-CPT
HEALTHCARE COMMON PROCEDURE CODING SYSTEM Correct answer-HCPCS
AMERICAN HOSPITAL ASSOCIATION Correct answer-AHA
MEDICARE SEVERITY DIAGNOSIS RELATED GROUP Correct answer-MS-DRG
physician must be immediately available; does not have to be in the room Correct answer-general
supervision
Service is under physician's control; provider must be directly available and on campus. Correct
answer-direct supervision
provider must be in the room during service Correct answer-personal supervision
*doctor and anesthesiologist fees
*durable medical equipment (DME)
*prosthetic devices
*ambulance services
*outside lab services
*certain drugs and biologicals Correct answer-Not included in APC reimbursement (may be billed
out separately from hospital): (6)
DURABLE MEDICAL EQUIPMENT Correct answer-DME
licensed physician, two - five years training Correct answer-Residents
physicians obtaining additional training Correct answer-Fellows
, coding within the charge master Correct answer-hard coding
OFFICE INSPECTOR GENERAL Correct answer-OIG
payment methodology where hospitals are reimbursed based on procedures performed in an outpt
or ambulatory facility. Correct answer-APC (ambulatory payment classification)
reimbursement method for inpatients Correct answer-MS-DRG (Medicare severity diagnosis
related group)
first year following graduation from med school; one year rotation Correct answer-Interns
STATUS INDICATOR Correct answer-SI
Medicare supplemental insurance plans; fill the gap between Medicare insurances Correct answer-
Medigap
Inpatient co-ins and deductibles Correct answer-Part A Medicare covers:
notice to a patient that a service may not be covered by Medicare, must be signed. Correct
answer-ABN (advanced beneficiary notice)
*Workers comp
*Auto accidents
*Employer group health plans
*1st month ESRD patients Correct answer-Medicare is secondary payer to: (4)
ADVANCED BENEIFICIARY NOTICE Correct answer-ABN
coding is done by personnel from other departments Correct answer-soft coding
condition code 20 and modifier GA Correct answer-If a patient refuses to sign or pay an ABN, but
still wants the service performed, what Condition Code and Modifier would be on the claim?
condition code 20 and modifier GZ Correct answer-If the patient demands the claim be sent to
Medicare, what condition code and modifier would be on the claim?
ABN not required, patient wants Medicare responce Correct answer-ABN condition code 20
Service is not covered, but denial from Medicare is needed for secondary insurance (all denied items
must be on a separate claim for Medicare) Correct answer-ABN condition code 21
ABN required for labs Correct answer-ABN condition code 32
True Correct answer-TRUE / FALSE
ABN's may not be used for bundled services
Used by MACs, identifies errors on claims, assigned APC number for services covered under OPPS.
Correct answer-OCE (outpt code editor)
created by OIG; compliance program guidelines for hospitals Correct answer-Federal Register
